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Research ArticleInterventional

A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning

B.W. Chong, B.R. Bendok, C. Krishna, M. Sattur, B.L. Brown, R.G. Tawk, D.A. Miller, L. Rangel-Castilla, H. Babiker, D.H. Frakes, A. Theiler, H. Cloft, D. Kallmes and G. Lanzino
American Journal of Neuroradiology October 2019, 40 (10) 1759-1765; DOI: https://doi.org/10.3174/ajnr.A6222
B.W. Chong
From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
eDepartment of Biological and Health Systems Engineering (B.W.C., D.H.F.), Arizona State University, Tempe, Arizona.
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B.R. Bendok
From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
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C. Krishna
From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
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M. Sattur
From the Department of Neurosurgery (B.W.C., B.R.B., C.K., M.S.), Mayo Clinic, Phoenix, Arizona
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B.L. Brown
bDepartment of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
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R.G. Tawk
bDepartment of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
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D.A. Miller
bDepartment of Neurosurgery (B.L.B., R.G.T., D.A.M.), Mayo Clinic, Jacksonville, Florida
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L. Rangel-Castilla
cDepartment of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
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H. Babiker
dEndovantage, LLC (H.B.), Phoenix, Arizona
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D.H. Frakes
eDepartment of Biological and Health Systems Engineering (B.W.C., D.H.F.), Arizona State University, Tempe, Arizona.
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A. Theiler
cDepartment of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
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H. Cloft
cDepartment of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
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D. Kallmes
cDepartment of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
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G. Lanzino
cDepartment of Neurosurgery (L.R.-C., A.T., H.C., D.K., G.L.), Mayo Clinic, Rochester, Minnesota
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    Sample simulation result from the SurgicalPreview computational modeling software showing a 3D model of the FD inside a pretreatment vessel (A), a frame from a deployment video (B), and a cross-section of the FD (red) and vessel (blue) at a position along the vessel centerline (C).

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    Fig 2.

    Examples of posttreatment clinical reconstructions (red/left) and pretreatment simulation results (black/right) for the same FD sizes. The deployment pairs are sorted in ascending order according to the difference between actual and simulated device lengths, which ranged from 1.58 to 4.06 mm.

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    Fig 3.

    Bland-Altman plots showing dots that represent differences between the actual clinical and simulated deployments in FD length (A) and FD diameter (B). The plots show the means for the deployment pairs on the x-axis and the differences between pairs on the y-axis.

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    Fig 4.

    Average FD diameters for the actual clinical and simulated deployments. Error bars in the clinical FD diameter measurements were calculated by averaging 15 random measurements of FD thickness along the length of each reconstructed FD model.

Tables

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    Table 1:

    Number of cases simulated and validated by physicians

    PhysicianInstitutionNo. of Cases Simulated/Validated
    1A1/1
    2A7/6
    3A6/5
    4B1/1
    5B1/0
    6B1/0
    7C2/1
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    Table 2:

    Survey questionnaire results on the impact of computational modeling

    Survey QuestionsResponses
    YesNoSomewhat
    Were the simulations useful for your planning?1801
    Did the simulations give you greater confidence in your device selection?1801
    Did the simulations change your device selection?1261
    Do you think the simulations reduced the number of devices that you used?2143
    Do you think the simulations reduced your operative time?4132
    • View popup
    Table 3:

    Statistical analysis of the difference between clinical and simulated FD lengths and diameters for the 14 validated cases

    DifferenceAbsolute Difference
    Mean (mm)SD (mm)95% CI (mm)Mean (mm)SD (mm)95% CI (mm)
    FD length1.102.28[–0.21, 2.42]2.091.34[1.32, 2.86]
    FD diameter–0.120.30[–0.30, 0.05]0.280.16[0.18, 0.37]
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American Journal of Neuroradiology: 40 (10)
American Journal of Neuroradiology
Vol. 40, Issue 10
1 Oct 2019
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A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning
B.W. Chong, B.R. Bendok, C. Krishna, M. Sattur, B.L. Brown, R.G. Tawk, D.A. Miller, L. Rangel-Castilla, H. Babiker, D.H. Frakes, A. Theiler, H. Cloft, D. Kallmes, G. Lanzino
American Journal of Neuroradiology Oct 2019, 40 (10) 1759-1765; DOI: 10.3174/ajnr.A6222

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A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning
B.W. Chong, B.R. Bendok, C. Krishna, M. Sattur, B.L. Brown, R.G. Tawk, D.A. Miller, L. Rangel-Castilla, H. Babiker, D.H. Frakes, A. Theiler, H. Cloft, D. Kallmes, G. Lanzino
American Journal of Neuroradiology Oct 2019, 40 (10) 1759-1765; DOI: 10.3174/ajnr.A6222
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